Healthcare Provider Details

I. General information

NPI: 1801743836
Provider Name (Legal Business Name): RYLAN LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GILMAN DR
LA JOLLA CA
92093-5004
US

IV. Provider business mailing address

2618 TERESINA DR
HACIENDA HEIGHTS CA
91745-5317
US

V. Phone/Fax

Practice location:
  • Phone: 858-534-0830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: